A computer-assisted technology for complicated sinus surgery cases is
giving surgeons much more confidence in the safety and effectiveness of
what can sometimes be a dangerous procedure.

"Sinus surgery is one of the most dangerous things we do,"
according to Emory otolaryngologist (ENT specialist) Todd Kingdom, M.D.,
"and it becomes even more dangerous in revision cases where a patient
has already had multiple surgeries." Although the normal anatomy of
the sinuses is well known, that anatomy varies from patient to patient and
is distorted in revision cases. The biggest risk of sinus surgery is
injury
to the brain or eye.

"Image-guided sinus surgery helps us identify where those
structures
are and perform a more complete removal of diseased tissue while
increasing
safety," says Dr. Kingdom.

The new procedure, also called stealth technology, combines computer
technology with sophisticated imaging techniques, and is the newest
development
in the field. Using a navigational system developed by Sofamor Danek,
Inc.,
Emory ENT surgeons Kingdom, William Grist, M.D., and John DelGaudio, M.D.,
place a hand-held probe in the patient's nose while correlating their
position
with a special CT scan of the patient's sinuses visible on a computer
screen.
The new system allows surgeons to safely look for trouble spots, navigate
around them and avoid them.

The sinuses are the eight air-filled cavities close to your nose and
eyes that drain mucous into the nasal passages. When infected, they become
blocked and filled with fluid, causing pressure around the face and eyes,
headache, nasal discharge, a chronic cold and sometimes fever. Sinus
infections
result from allergies that produce mucous and block the tiny passages that
drain the sinuses. Viral infections also can infect the cells lining the
nasal passages, causing them to swell and produce mucus. Chronic allergies
that lead to repeated episodes of swelling and mucus production can cause
permanent thickening of the lining of the sinuses and the formation of
polyps.
Any kind of blockage can lead to further difficulties with drainage and
more susceptibility to infection.

Although nearly 50 million Americans suffer from occasional or frequent
sinus infections, most find relief in nasal decongestants, hot compresses,
non-prescription pain relievers or antibiotics. In some people, though,
chronic sinus infections do not respond to these common remedies and may
require sinus surgery to allow drainage and healing. Using the
state-of-the-art
technique, surgeons work through the nose with endoscopes (small lighted
telescopes) and remove the obstructive tissue. Straightforward first-time
sinus surgery in the hands of a well-trained surgeon typically does not
require stealth technology, Dr. Kingdom points out.

Revision cases, however, where patients have had previous, often
multiple,
sinus surgeries, present the greatest challenge to surgeons, Dr. Kingdom
says. "Although nothing replaces anatomic knowledge of the surgeon,
the stealth system is an adjunct that helps localize exactly where the
growth
is, the extent of it, how much needs to be removed, and how close we are
to structures like the eye or the brain. This technology also is useful
for benign and cancerous tumors of the sinus cavity or tumors in the
skull-based
area."